Study Suggests Women on Medicaid More Likely To Receive Mastectomy To Treat Breast Cancer

In a study reported in the resident’s forum, Linda Adepoju, M.D., of University of Toledo Medical Center, Ohio, and colleagues suggest that tumor size, cancer stage, and Medicaid insurance were predictors of undergoing a mastectomy to treat breast cancer. (Online First)

A total of 1,539 women with stage I through stage III invasive breast cancer who had surgery between 1996 and 2009 were included in the retrospective study. Of those participating, 651 (42 percent) were treated with mastectomy and 888 (58 percent) were treated with breast-conserving treatment (BCT).

Women with Medicaid has significantly larger tumors compared with those with private insurance (PI) at diagnosis (3.3 cm versus 2.1 cm) and were more likely to be treated with mastectomy for larger tumors compared with women with PI. However, women with PI were more likely to have mastectomy for smaller tumors; among women with tumors less than 2cm, 11% with Medicaid underwent mastectomy compared with 47% with PI. Overall, when compared with those with PI, women with Medicaid were more likely to receive mastectomy (60 percent versus. 39 percent), the study finds. 

“Early detection efforts, such as increasing the rate of screening mammography among Medicaid patients, could increase the number of patients who receive BCT,” the authors conclude.

JAMA Surg. Published online April 24, 2013. doi: 10.1001/jamasurg.2013.61.